Comparison Of Etomidate-Remifentanil And Propofol-Remifentanil Sedation In Overweight Or Obese Patients Prior To Diagnostic Upper Gastrointestinal Endoscopy

Objective: This study is to compare the hemodynamic responses, recovery and discharge times, diagnostic accuracy, patient and examiner satisfaction and adverse events of etomidate-remifentanil and propofol-remifentanil sedation in overweight or obese patients undergoing diagnostic gastroscopy. Methods: Three hundred overweight or obese patients (body mass index >= 25 kg/m(2)) scheduled for diagnostic gastroscopy received intravenous etomidate-remifentanil (n = 150) or propofol-remifentanil sedation (n = 150), randomly. Remifentanil (0.4-0.6 mu g/kg) was infused in all patients. Patients in the etomidate group received etomidate with an initial dose of 0.1-0.15 mg/kg followed by an additional dose of 4-6 mg/kg. Patients in the propofol group received propofol with an initial dose of 1-2 mg/kg and an additional dose of 20-40 mg/kg. The primary outcome was the Hemodynamic responses. The secondary outcomes included discharge times, diagnostic accuracy and patient and examiner satisfaction (The registration number: ChiCTR-TRC-13003162). Results: Etomidate-remifentanil caused less decreased levels of systolic blood pressure (SBP, P < 0.01), diastolic blood pressure (DBP, P < 0.01), SpO(2) (P < 0.01) and heart rate (HR, P < 0.05) than propofol-remifentanil. The onset time was earlier in the etomidate group (P < 0.01). Incidences of hypoxemia, hypotension and injection pain were higher in the propofol group (all P < 0.01), while those of myoclonus and nausea-vomiting were higher in the etomidate group (all P < 0.01). Satisfaction of physician and anesthetist in the propofol group was better. Conclusions: Etomidate-remifentanil sedation is feasible for overweight or obese patients undergoing gastroscopy.